Importance:The efficacy and safety of guideline-recommended treatments for heart failure (HF) are uncertain in patients with Chagas disease. Objective:To evaluate the efficacy and safety of the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan in patients with HF with reduced ejection fraction due to Chagas disease. Design, Setting, and Participants:From December 10, 2019, through September 13, 2023, patients with HF, confirmed diagnosis of Chagas disease, left ventricular ejection fraction of 40% or less, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) of 600 pg/mL or greater (or B-type natriuretic peptide [BNP] ≥150 pg/mL) or 400 pg/mL or greater (or BNP ≥100 pg/mL) if hospitalized for HF within the previous 12 months were screened at 83 sites in Argentina, Brazil, Colombia, and Mexico. Statistical analysis was conducted between May and July 2025. Interventions:Patients were randomized to receive sacubitril/valsartan (target dose, 200 mg twice daily) or enalapril (target dose, 10 mg twice daily), in addition to standard therapy. Main Outcomes and Measures:The primary end point was a hierarchical composite outcome tested, in order, of death from cardiovascular causes, hospitalization for HF, or relative change in NT-proBNP from baseline to 12 weeks. The primary analysis was done using a win ratio approach. Results:Overall, 462 participants were randomized to receive sacubitril/valsartan and 460 to receive enalapril (mean [SD] age, 64.2 [10.8] years; 387 [42.0%] were female). Over a median (IQR) follow-up of 25.2 (18.4-33.2) months, cardiovascular death occurred in 110 patients (23.8% [18.3% wins in the hierarchical comparison]) in the sacubitril/valsartan group and 117 patients (25.4% [17.5% wins]) in the enalapril group. A total of 102 patients (22.1% [7.7% wins]) in the sacubitril/valsartan group and 111 (24.1% [6.9% wins]) in the enalapril group experienced a first hospitalization for HF. Patients in the sacubitril/valsartan group had a median (IQR) decrease in NT-proBNP of 30.6% (-54.3% to -0.9%) at 12 weeks, leading to 22.5% wins, while those in the enalapril group had a 5.5% (-31.9% to 37.5%) decrease (7.2% wins). The resulting stratified win ratio was 1.52 (95% CI, 1.28-1.82; P < .001) for sacubitril/valsartan compared with enalapril. Conclusions and Relevance:In patients with HF with reduced ejection fraction due to Chagas disease, there was no significant difference in clinical outcomes between sacubitril/valsartan and enalapril, but there was a greater reduction in NT-proBNP at 12 weeks in patients in the sacubitril/valsartan group. Trial Registration:ClinicalTrials.gov Identifier: NCT04023227.

The efficacy and safety of guideline-recommended treatments for heart failure (HF) are uncertain in patients with Chagas disease. To evaluate the efficacy and safety of the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan in patients with HF with reduced ejection fraction due to Chagas disease. From December 10, 2019, through September 13, 2023, patients with HF, confirmed diagnosis of Chagas disease, left ventricular ejection fraction of 40% or less, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) of 600 pg/mL or greater (or B-type natriuretic peptide [BNP] ≥150 pg/mL) or 400 pg/mL or greater (or BNP ≥100 pg/mL) if hospitalized for HF within the previous 12 months were screened at 83 sites in Argentina, Brazil, Colombia, and Mexico. Statistical analysis was conducted between May and July 2025. Patients were randomized to receive sacubitril/valsartan (target dose, 200 mg twice daily) or enalapril (target dose, 10 mg twice daily), in addition to standard therapy. The primary end point was a hierarchical composite outcome tested, in order, of death from cardiovascular causes, hospitalization for HF, or relative change in NT-proBNP from baseline to 12 weeks. The primary analysis was done using a win ratio approach. Overall, 462 participants were randomized to receive sacubitril/valsartan and 460 to receive enalapril (mean [SD] age, 64.2 [10.8] years; 387 [42.0%] were female). Over a median (IQR) follow-up of 25.2 (18.4-33.2) months, cardiovascular death occurred in 110 patients (23.8% [18.3% wins in the hierarchical comparison]) in the sacubitril/valsartan group and 117 patients (25.4% [17.5% wins]) in the enalapril group. A total of 102 patients (22.1% [7.7% wins]) in the sacubitril/valsartan group and 111 (24.1% [6.9% wins]) in the enalapril group experienced a first hospitalization for HF. Patients in the sacubitril/valsartan group had a median (IQR) decrease in NT-proBNP of 30.6% (−54.3% to −0.9%) at 12 weeks, leading to 22.5% wins, while those in the enalapril group had a 5.5% (−31.9% to 37.5%) decrease (7.2% wins). The resulting stratified win ratio was 1.52 (95% CI, 1.28-1.82; P < .001) for sacubitril/valsartan compared with enalapril. In patients with HF with reduced ejection fraction due to Chagas disease, there was no significant difference in clinical outcomes between sacubitril/valsartan and enalapril, but there was a greater reduction in NT-proBNP at 12 weeks in patients in the sacubitril/valsartan group. ClinicalTrials.gov Identifier: NCT04023227

Resumo Fundamento A insuficiência cardíaca (IC) é uma das principais causas de morbidade e mortalidade no mundo. Poucos estudos avaliaram a sobrevida e fatores prognósticos de pacientes com esta condição frente aos avanços terapêuticos das últimas décadas. Objetivos Descrever a sobrevida, possíveis fatores associados a mortalidade e características clínicas dos participantes com IC do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Métodos A coorte acompanhou 15.105 participantes, entre 2008 e 2023. Foram avaliadas variáveis sociodemográficas, exames laboratoriais, eletrocardiograma, ecocardiograma bidimensional, hábitos de vida, comorbidades e tratamento medicamentoso. A probabilidade de sobrevida foi estimada através das curvas de Kaplan-Meier e testes de log-rank. Modelagem de regressão de Cox, permitiu calcular as Hazard Ratios (HR), brutas e ajustadas, com seus respectivos intervalos de confiança de 95%. Utilizou-se o critério de significância p<0,05. Resultados Durante a etapa de inclusão, foram selecionados 251 participantes com diagnóstico de IC (2008-2010). No período aproximado de 12,3 anos de acompanhamento, 48(19%) faleceram. A sobrevida global dos participantes com IC nos 2, 6, 10 e 12,3 anos de seguimento, foi de 96%, 89%, 82% e 80% respectivamente. O risco de mortalidade foi 4,5 vezes maior (HR:4,46; IC95%: 3,3–5,9) em comparação com o grupo não acometido, (p<0,01) e mesmo após a aplicação de modelo ajustado, o risco de mortalidade permaneceu duas vezes mais elevado, (HR:1,77; IC95%:1,3–2,4). As variáveis associadas a pior prognóstico foram: sexo masculino, idade avançada, disfunção sistólica (FEVE<45%), hipertensão arterial, diabetes mellitus e doença renal crônica. Conclusão Encontramos elevada mortalidade em participantes com IC na coorte ELSA-Brasil.

BACKGROUND:Nurses provide essential care for symptomatic chronic Chagas disease carriers, caused by Trypanosoma cruzi, offering crucial support, symptom management, medication administration, and monitoring to enhance their health-related quality of life. OBJECTIVE:To increase healthcare professionals' awareness of the critical role played by high-quality care in the management of patients with chronic Chagas disease. METHODS:This scoping review employed the PRISMA-ScR method as a framework for article selection. A comprehensive search was conducted in the Scielo Brazil, PubMed, and LILACS databases, using the keywords "Chagas disease," "nursing," "nursing care", and "nursing assistance" in Portuguese, English, and Spanish. The search covered the period from 1980 to 2022. The initial review identified a total of 633 studies, from which 17 studies were ultimately selected for analysis. These included two observational studies, two case series, and seven literature reviews. RESULTS:These studies underscored the crucial role of nurses in supporting patients with chronic Chagas disease, particularly those with cardiac and/or digestive manifestations. Additionally, interventions pertaining to neonates with the infection and users of pacemakers/implantable cardioverter defibrillators were examined. CONCLUSION:Nurses play a critical role within a multidisciplinary care team in improving the health-related quality of life for individuals living with chronic Chagas disease, irrespective of the cardiac or digestive form of the disease. Therefore, it is essential to assess both the subjective and objective needs of infected individuals in order to develop tailored nursing care plans that address their individualized needs and clinical conditions.

BACKGROUND:Heart failure (HF) is a clinical condition with high morbidity and mortality and a growing impact on global public health. Longitudinal studies with large samples and extended follow-up are essential to understand its incidence and risk factors in diverse populations. OBJECTIVE:To estimate the incidence over time and identify factors associated with the development of HF among participants of the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS:A cohort study with 14,854 ELSA-Brasil participants, followed for an average of 12.3 years. A total of 251 individuals with a previous diagnosis of HF at baseline (2008-2010) were excluded. Incident cases were identified in visits 2 (2012-2014) and 3 (2016-2018). Cumulative incidence and incidence rates were estimated. Bivariate comparisons were performed using the chi-square test, while multivariate analysis employed Cox regression to estimate crude and adjusted Hazard Ratios (HR) with 95% confidence intervals (95% CI). A statistical significance level of p < 0.05 was adopted. RESULTS:The incidence of HF was 1.35 per 1,000 person-years (1.39% cumulative) over visits 2 and 3, with 93 new cases in visit 2 (0.61 per 1,000 person-years; 0.63% cumulative) and 113 new cases in visit 3 (0.74 per 1,000 person-years; 0.76% cumulative). Incidence was higher among older adults (65-74 years), self-reported Black individuals, and those with excess weight. Advanced age and abdominal obesity were risk factors present in both visits, while Chagas disease, valvular heart disease, and smoking were specific predictors in visit 2, and hypertension, rheumatic fever, angina, and fatigue were predictors in visit 3. CONCLUSION:The study highlights the progression of heart failure (HF) incidence and identifies important modifiable risk factors in the Brazilian population, reinforcing the need for preventive strategies and public policies focused on early detection and management of HF.

BACKGROUND:High blood pressure (BP) values have traditionally been associated with the risk of ischemic heart disease, stroke, chronic kidney disease, and early mortality. The brachial artery FMD after cuff deflation has become the standard parameter for quantifying endothelial function, being a useful surrogate outcome due to its non-invasiveness, close correlation with coronary endothelial function, and association with the incidence of long-term coronary events. OBJECTIVES:To test hypotheses of correlation between the FMD and several blood parameters and to compare parameters between altered and non-altered FMD groups, and between hypertensive patients in the resistant hypertension groups (RHTN and non-RHTN). METHODS:Seventy-two volunteers from a referral hypertension outpatient clinic participated in this prospective cross-sectional study, in which several patient variables were compared between the altered FMD (n = 38) and non-altered FMD (n = 34) groups, and also between the RHTN (n = 49) and non-RHTN (n = 23) groups. The variables that would explain the FMD were also investigated in this study. Statistical analyses were performed using parametric methods when the assumptions were met, and non-parametric methods otherwise. The significance level adopted in the statistical analysis was 5%. RESULTS:The results showed a significant positive correlation between the FMD and LDL (p = 0.204, p = 0.042) and between FMD and triglycerides (p = 0.247, p = 0.037). Glycated hemoglobin was higher in the RHTN group (p = 0.020), potassium was higher in the non-RHTN group (p = 0.029), and C-reactive protein was higher in the RHTN group (p = 0.04). For the other comparisons, no statistically significant differences were found. CONCLUSION:LDL and triglycerides are FMD predictors, and the RHTN and non-RHTN groups differ in terms of the amount of potassium, protein C, and glycated hemoglobin. The altered and non-altered FMD groups differ only in terms of triglycerides.

Resumo Fundamento Valores elevados de pressão arterial (PA) têm sido tradicionalmente associados ao risco de doença isquêmica do coração, acidente vascular cerebral, doença renal crônica e mortalidade precoce. A dilatação mediada por fluxo (FMD) da artéria braquial após a desinsuflação do manguito tornou-se o parâmetro padrão para quantificar a função endotelial, sendo um desfecho substituto útil em função de sua não invasividade, estreita correlação com a função endotelial coronariana e associação com a incidência de eventos coronarianos em longo prazo. Objetivos Testar hipóteses de correlação entre a FMD e diversos parâmetros sanguíneos e comparar os parâmetros entre grupos com a FMD alterada e não alterada e entre hipertensos dos grupos hipertensão arterial resistente (HAR e não HAR). Métodos Setenta e dois voluntários de um ambulatório de referência em Hipertensão Arterial foram incluídos neste estudo transversal prospectivo, no qual foram comparadas diversas variáveis mensuradas nos pacientes, entre os grupos FMD alterada (n = 38) e não alterada (n = 34), e também entre os grupos HAR (n = 49) e não HAR (n = 23). Investigamos também quais variáveis explicariam a FMD. As análises estatísticas foram conduzidas por meio de métodos paramétricos quando os pressupostos foram atendidos e não paramétricos quando estes não foram atendidos. O nível de significância adotado nas análises estatísticas foi de 5%. Resultados Os resultados mostraram uma correlação positiva significativa entre FMD e LDL (p = 0,204, p = 0,042) e entre FMD e triglicerídeos (p = 0,247, p = 0,037). Hemoglobina glicada foi maior no grupo HAR (p = 0,020), potássio foi maior no grupo não HAR (p = 0,029) e proteína C reativa foi maior no grupo HAR (p = 0,04). Não houve diferenças estatísticas significativas para as demais comparações. Conclusões O LDL e os triglicerídeos são preditores da FMD e os grupos HAR e não HAR diferem quanto à quantidade de potássio, proteína C e hemoglobina glicada. Os grupos de FMD alterada e não alterada diferem somente em relação aos triglicerídeos.

BACKGROUND:Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. Few studies have evaluated the survival and prognostic factors of patients with this condition in light of the therapeutic advances of recent decades. OBJECTIVES:To describe the survival, possible factors associated with mortality, and clinical characteristics of participants with HF in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS:The cohort followed 15105 participants from 2008 to 2023. Sociodemographic variables, laboratory tests, electrocardiogram, two-dimensional echocardiogram, lifestyle habits, comorbidities, and medication use were evaluated. Survival probability was estimated using Kaplan-Meier curves and log-rank tests. Cox regression modeling was used to calculate the crude and adjusted Hazard Ratios (HR) with their respective 95% confidence intervals. The significance criterion was p<0.05. RESULTS:During the inclusion phase, 251 participants with an HF diagnosis were selected (2008-2010). Over approximately 12.3 years of follow-up, 48 (19%) died. The overall survival of participants with HF at 2, 6, 10, and 12.3 years of follow-up was 96%, 89%, 82%, and 80%, respectively. The mortality risk was 4.5 times higher (HR: 4.46; 95% CI: 3.3-5.9) compared to the unaffected group (p<0.01), and even after applying an adjusted model, the mortality risk remained twice as high (HR: 1.77; 95% CI: 1.3-2.4). Variables associated with a worse prognosis included male sex, advanced age, systolic dysfunction (LVEF<45%), hypertension, diabetes mellitus, and chronic kidney disease. CONCLUSION:We found high mortality among participants with HF in the ELSA-Brasil cohort.

Background The present study evaluated the clinical features and safety of surgical strategies and treatments for true arterial aneurysms of the hand. Methods A systematic search of the PubMed, Embase, Web of Science, Scopus, and CINAHL databases for clinical trials, case series, and case reports investigating true arterial aneurysms of the hand, published over the past 10 years, was performed. The inclusion criterion was surgical excision of arterial aneurysm, followed by arterial revascularization or ligation. Studies addressing pseudoaneurysms, mycotic aneurysms, conservative treatment, or no treatment were excluded. Summary level data regarding study characteristics and outcomes of amputation, neurological symptoms, number of preoperative vascular imaging examinations, and length of hospital stay were extracted. Results Thirty-nine studies comprising 48 patients (mean [± SD] age, 41.1±22 years [range 0.5–80 years]; 39 [81.25%] male) were included. Thirty (62.5%) patients underwent only 1 preoperative examination and traumatic etiology was observed in 52.1% (n=25). The most prevalent intervention was aneurysm excision, followed by arterial revascularization (n=35 [72.9%]), with no amputations. Neurological symptoms were present in 8 (16.6%) subjects, with no difference between the revascularization and arterial ligation groups (odds ratio [OR] 3.36 [95% confidence interval (CI) 0.37–30.5]). The mean length of hospital stay was 1.44 days (range 0–4 days), with no difference between revascularization and arterial ligation (OR 2.5 [95% CI 0.10–62.6]). Conclusion This review did not find amputation rate outcomes associated with either technique, although similar neurological outcomes were observed. Nevertheless, the retrieved data were limited to those ensuring the safety of both procedures.

Aim The study aimed to evaluate biomarkers, ratios, and indexes as flags of coronary obstructions in women with established coronary atherosclerotic disease regardless of diabetes. Methods A cross-sectional study was conducted on 42 confirmed atherosclerotic coronary female patients, stratified into diabetic or not and scheduled for angioplasty or coronary graft bypass surgery. Blood samples were collected immediately before coronary intervention for laboratory determinations, such as glycemia, HbA1c, insulin, HDL-C, PON-1, free cholesterol, LDL-C, Apo A-1, Apo B, and TG. Results In diabetic patients, insulin was positively correlated with triglycerides (p < 0.0108; r = 0.2009), apo B (p < 0.0006; r = 0.3737), non-HDL cholesterol (p < 0.0084; r = 0.2156), and free cholesterol (p < 0.0084; r = 0.3251). Applying a linear regression model, insulin from diabetic patients showed an association with glycemia, triglycerides, and HOMA-IR (p < 0.001, R2 = 0.9868), but in non-diabetics, the association was only found between insulin and HOMA-IR (p = 0.002, R2 = 0.9031). On the other hand, using triglycerides as a dependent variable, its association has been found in both groups, but only with HOMA-IR (diabetics: p = 0.006, R2 = 0.2504; non-diabetics: p = 0.014, R2 = 0.4697). Also, the TG/HDL-C ratio was higher than 2.5 in 90% of diabetics and 83.33% of non-diabetic patients. Conclusion The high prevalence of females with a TG/HDL-C ratio above 2.5, the association among insulin, HOMA-IR, and TG/HDL-C, and correlations with apoB, non-HDL-C, and free cholesterol, should be evaluated as flags of female precocious coronary atherosclerosis.

Based on the results of this meta-analysis, the effect of hormone therapy on blood pressure is influenced by the formulation used, especially the type of estrogen. ImportanceMenopausal hormone therapy (HT) includes a wide variety of hormonal compounds, and its effect on blood pressure is still uncertain.ObjectiveThe aim of this study was to assess evidence regarding the effect of HT on blood pressure in postmenopausal women and its association with arterial hypertension.Evidence ReviewThis systematic review and meta-analysis included randomized clinical trials and prospective observational studies. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and the incidence of hypertension were assessed. All stages were independently performed by two reviewers. For blood pressure outcome, standardized mean differences (SMD) and 95% confidence intervals (95% CI) were calculated as effect measures. Heterogeneity was assessed using the I2 statistic. The results are presented based on the HT type. The incidence of hypertension was compared using descriptive analyses.FindingsEleven studies were included with 81,041 women evaluated, of which 29,812 used HT. The meta-analysis, conducted with 8 studies and 1,718 women, showed an increase in SBP with the use of oral conjugated equine estrogens plus progestogen (SMD = 0.60 mm Hg, 95% CI = 0.19 to 1.01). However, oral or transdermal use of estradiol plus progestogen (SMD = -2.00 mm Hg, 95% CI = -7.26 to 3.27), estradiol alone, and tibolone did not show any significant effect. No significant effect on DBP was observed for any formulation. Women who used oral estrogen plus progestogen had a higher risk of incident hypertension than those who never used it.Conclusions and RelevanceThe effect of HT on blood pressure is influenced by the formulation used, especially the type of estrogen. The combined formulations of conjugated equine estrogens plus progestogen increased SBP and the risk of hypertension, which was not observed among estradiol plus progestogen, estradiol alone, and tibolone users.

Introduction: Glibenclamide (GBC), although traditionally used to treat type 2 diabetes mellitus, has demonstrated efficacy in preventing cerebral edema in the setting of stroke, including preserving the integrity of the vascular endothelium, reducing edema and inhibiting brain death. The objective is to investigate the effects of glibenclamide in individuals who have suffered a stroke. Methods: This is a systematic review. The following databases were used: EMBASE, MEDLINE, Lilacs, Scielo, Cochrane Library and Science Direct. Data collection was carried out from June to November 2023. Studies were included in which the effects of glibenclamide were evaluated in individuals (of both sexes and without age restrictions) diagnosed with stroke. The studies should have been published in the last 10 years; there was no restriction on the language of publication. Review studies and studies that included other pathologies in the same group were excluded. Results: 10 articles were included. The total number of participants was 853 individuals. The results of the studies demonstrated, in general, lower mortality, reduction in midline displacement and cerebral edema in the groups that used glibencamide. There were no hemorrhagic events or hypoglycemia. Conclusions: The use of glibenclamide had a favorable effect on individuals who had suffered a stroke. However, new studies with a larger sample size and involving other databases are needed so that these results can be generalized and the use of GBC in stroke can be validated. (c) 2024 International Hemorrhagic Stroke Association. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BACKGROUND:Cerebrovascular accident (or stroke) and ischemic heart disease are the the major causes of death in the world. It is estimated that about 85% of strokes are ischemic in origin. Reperfusion therapy in the acute phase of ischemic stroke with a recombinant human tissue plasminogen activator is effective, but some factors influence the success of this treatment.OBJECTIVE:The aim of this study was to evaluate clinical aspects and possible determinants for reperfusion after venous thrombolysis.METHODS:This is a retrospective, cross-sectional, observational study based on a review of hospital records of inpatients diagnosed with ischemic stroke treated with intravenous thrombolysis, the main outcome being reperfusion or not.RESULTS:Data from this study revealed a predominance of females in the group of reperfused patients and males in the non-reperfused group, both maintaining moderate severity on the National Institutes of Health Stroke Scale and admission without statistical significance (p>0.18). In addition, the mean admission severity score was 13.2 for the group of reperfused patients and 14.2 for those not reperfused, and the mean ejection fraction of both groups was within normal functionality, with a mean of 0.50 for reperfused patients and 0.62 for non-reperfused patients.CONCLUSION:We found an association between successful venous chemical thrombolysis reperfusion and lower mortality in patients with acute stroke.

Background: Systemic arterial hypertension is a multicausal and multifactorial disease of high prevalence worldwide. The development, progression, and damage of target organs are associated not only with genetic and environmental factors, but also epigenetic factors, such as the regulation by microRNAs (miRNAs). MiRNAs – including miRNA-1-3p, miRNA-21-5p and miRNA-126-5p have been described as potential biomarkers in hypertension, type 2 diabetes and obesity, but their role of in the development and progression of the disease has been little explored. In the present study, we analyzed the expression of these three miRNAs in the serum of hypertensive, diabetic and obese patients compared with a healthy group and correlated with clinical and laboratory parameters. Methods: Using RT-qPCR, the expression of miRNA-1-3p, miRNA-21-5p and miRNA-126-5p was analyzed in the serum of 50 participants, control (n = 8), hypertensive only (n = 21), hypertensive in association with diabetes and obesity (n = 21). Results: The expression of miRNA-126-5p was significantly high in the hypertensive group when compared to the control group (p= 0.0170), however there was no statistical difference when compared to the hypertensive, diabetic and obese group. MiRNA-1-3p and miRNA-21-5p showed no statistical differences between groups. The correlation analysis showed a positive correlation of miRNA-126-5p with creatinine and a negative correlation with platelets. Conclusion: This study demonstrated that miRNA-126-5p is overexpressed in the serum of hypertensive patients, and may have a potential as a biomarker of early target kidney injury.

Stress-inducing factors experienced by professionals working in intensive care units (ICUs) during the COVID-19 pandemic have detrimental effects on their mental and physical well-being. The COVID-19 outbreak led to a surge in the number of patients requiring critical care, necessitating the dedicated efforts of ICU workers. However, the introduction of COVID-19 posed significant threats to their health and safety. To investigate the impact of these stressors, researchers employed a comprehensive questionnaire consisting of 75 questions covering personal aspects, job satisfaction, salary, working hours, impact on family activities, and emotional and psychological balance. The results indicated that the model used in the study was statistically adequate according to the Hosmer & Lemeshow test (p = 0.58). Furthermore, the Omnibus Tests demonstrated an improved equation with the model, as indicated by a Chi-square value of 36.372, 8 degrees of freedom, and p < .000. Nargle Kerke's R2 coefficient suggested that the model accounted for 37% of the variance associated with exhaustion. Importantly, a positive association was observed between exhaustion and job satisfaction (24.92). In conclusion, the study revealed higher levels of exhaustion among nurses, females, professionals using controlled medication, those who did not rest after work, and those juggling multiple jobs. These findings underscore the need for a more comprehensive analysis of the identified attributes within the context of care provision, particularly as the pandemic evolves.

Angiolymphoid Hyperplasia with Eosinophilia (ALHE) is a benign vascular proliferative disorder with uncertain etiology and pathogenesis. The aim of this paper is to report a case of ALHE in the temporal artery and discuss the general aspects of this pathology. A 29-year-old female black patient sought the Vascular Surgery Outpatient Service, complaining of bulging in the right temporal region, associated with pain and local discomfort. Physical examination revealed pulsatile bulging in the right temporal region measuring approximately 2.5 × 1.5 cm. Nuclear Magnetic Resonance showed an expansive fusiform lesion in the superficial soft parts of the right temporal region, measuring 2.9 cm in the longest longitudinal axis. Surgical excision proved to be the best therapeutic option for the patient in this case. Histopathological sections showed the proliferation of vessels of different sizes, covered by swollen endothelium, prominent inflammatory infiltrate composed of lymphocytes, plasma cells, eosinophils, and scarce histiocytes. Immunohistochemical analysis of the lesion showed positivity for CD31, corroborating the diagnosis of ALHE.